Despite the recent improvements in the economy, many struggling Americans have to decide whether to pay for food, the rent – or their medications. A study published in the American Journal of Medicine (AJM), Treat or Eat: Food Insecurity, Cost-Related Medication Underuse and Unmet Needs, reports on a statistical analysis of 9,696 chronically ill adults performed to relate cost-related under-medication underuse to food insecurity. Study participants from the National Health Interview Survey (NHIS) suffered from a variety of illnesses, including arthritis, asthma, cancer, heart disease, COPD, diabetes mellitus, hypertension, stroke, and psychiatric conditions.
Out of the study’s participants, 23.4 percent reported cost-based under-medication, 18.8 percent experienced food insecurity, and 11 percent of the study participants reported both food insecurity and cost-related under-medication. Those experiencing food insecurity were much more likely to also experience cost-related medication underuse. Study subjects experiencing both food insecurity and cost-related under-medication were disproportionately black or Hispanic, and likely to have more chronic conditions.
The implications of under-medication vary depending on the disease being treated. Compliance with medication is critical for disease management and successful treatment. In the case of cardiovascular disease, if the patient being treated does not make his physician aware of the underuse of a prescribed medication, the doctor may assume the medication is not working, and increase the prescription or prescribe a second drug. For patients on anti-depressants or anti-psychotics, non-compliance with the medications can lead to relapse and re-occurrence of symptoms. In the case of antibiotics, there is a well-established link between under-medication with antibiotics and evolution of antibiotic-resistant strains of bacteria that can be difficult to eradicate.
The problem of cost-related medication underuse is compounded when one takes into account the numerous other factors that also affect medication compliance. Patients with psychiatric conditions may resist their medication regimen due to paranoia or disorganization; some medications have intolerable side effects, such as weight gain or tardive dyskinesia (a neurological disorder resulting in involuntary, repetitive body movements). Patients taking antibiotics may exhibit poor compliance, especially with a longer and more complex medication regimen. Non-compliance with a medication generally affects treatment outcome adversely and prolongs length of treatment, thereby increasing the cost of the treatment.
Despite a stronger economy at present, many Americans are still forced to make sacrifices for basic necessities. A 2012 survey found that one in five Americans were finding it difficult to pay for basic needs; one in six reported they had no form of health insurance, although this figure will likely improve as the Affordable Care Act is progressively implemented. The current study found that the decision to pay food, medication, or rent for struggling Americans is directly impacted by participation in social support programs such as WIC (Women, Infants, and Children) food and nutrition benefits, and Medicaid. Unsurprisingly, study subjects who participated in these programs were less likely to experience food insecurity or cost-related under-medication.
Many struggling Americans suffering from chronic illness still wrestle with the decision to pay the rent, put food on the table, or pay for medications. The lead investigator in the AJM study, Dr. Seth A. Berkowitz of Massachusetts General Hospital and Harvard Medical School, concluded that social support programs that target food insecurity or cost-related under-medication might produce substantial health gains for patients facing the “treat or eat” question, and free up available resources to further assist vulnerable patients.
By Laura Prendergast